MyMedR

Differences in vitamin D status and calcium intake: possible explanations for the regional variations in the prevalence of hypercalcemia in tuberculosis

Chan TY

Calcif. Tissue Int., 1997 Jan;60(1):91-3.

PMID: 9030487

The prevalence of hypercalcemia in patients with untreated tuberculosis (TB) varies widely between countries. Since the vitamin D status and calcium intake are important determinants of hypercalcemia in TB, these two factors were compared among four populations (U.K., Hong Kong, Malaysia, Thailand) with a low prevalence (<3%) and two populations (Sweden, Australia) with a high prevalence (>25%). In the three Asian countries, the circulating vitamin D levels are abundant, but the calcium intakes are low. Subjects from the U.K. have the lowest circulating vitamin D level of all, although their calcium intake is high. In Sweden and Australia, both the circulating vitamin D levels and calcium intakes are high. Since serum 1,25(OH)2D concentration will only be raised if its substance for extrarenal conversion, 25(OH)D, is plentiful and the effect of a given serum 1,25 (OH)2D concentration on serum calcium is determined by the calcium intake, it is postulated that the regional variation in the prevalence of hypercalcemia in TB may be due to differences in the circulating vitamin D levels and calcium intakes in these populations.

Matched MeSH terms: Hypercalcemia/etiology*; Hypercalcemia/epidemiology

Low incidence of hypercalcaemia in tuberculosis in Malaysia

Tan TT, Lee BC, Khalid BA

J Trop Med Hyg, 1993 Dec;96(6):349-51.

PMID: 8254712

In this study we examined the incidence of hypercalcaemia among patients with tuberculosis in Malaysia. Serum calcium concentration and other calcium metabolism parameters were studied in 43 newly diagnosed tuberculous patients from the Kuala Lumpur General Hospital and the National Tuberculosis Centre. Forty-four patients admitted to the medical wards of the General Hospital, Kuala Lumpur were recruited as controls. The incidence of hypercalcaemia was found to be only 1/43 (2.3%). There was no significant difference between the mean serum calcium and other calcium metabolism parameters between the patients and the controls. Despite earlier reported incidences of 30-50%, this study showed that hypercalcaemia in tuberculosis is uncommon in Malaysia.

Matched MeSH terms: Hypercalcemia/etiology*; Hypercalcemia/epidemiology

Hypercalcaemia: an unusual presenting feature of childhood acute lymphoblastic leukaemia

Rajagopal R, Lum SH, Jalaludin MY, Krishnan S, Abdullah WA, Ariffin H

Br J Haematol, 2013 Oct;163(2):147.

PMID: 23961807 DOI: 10.1111/bjh.12500

Matched MeSH terms: Hypercalcemia/diagnosis*; Hypercalcemia/etiology*

Use of denosumab in parathyroid carcinoma with refractory hypercalcemia

Tong CV, Hussein Z, Noor NM, Mohamad M, Ng WF

QJM, 2015 Jan;108(1):49-50.

PMID: 25099611 DOI: 10.1093/qjmed/hcu166

Matched MeSH terms: Hypercalcemia/blood; Hypercalcemia/drug therapy*; Hypercalcemia/etiology

Fulltext A retrospective study of serum calcium levels in a hospital population in Malaysia

Aishah AB, Foo YN

Med J Malaysia, 1995 Sep;50(3):246-9.

PMID: 8926903

A retrospective six-month study of serum calcium and albumin in patients treated at the Kuala Lumpur Hospital was carried out. There were 19,291 subjects, of which the prevalences of hypocalcemia (corrected serum calcium of < or = 2.1 mmol/l) and hypercalcemia (corrected serum calcium of > 2.7 mmol/l) were 18.0% (3460 subjects) and 2.4% (468 subjects) respectively. Persistent hypocalcemia (a minimum of first two consecutive corrected serum calcium of < or = 2.1 mmol/l) was found in 408/19,291 subjects 2.1%). Serum calcium values of < 2.00 mmol/l were found in 98.5% of this group. Persistent hypercalcemia (a minimum of first two consecutive corrected serum calcium of > 2.7 mmol/l) was found in 108/19,291 subjects (0.5%) and 52/108 subjects (48.1%) had serum calcium values of > or = 3.0 mmol/l. 2902/3460 subjects (83.8%) and 313/468 subjects (66.9%) the hypocalcemia and hypercalcemia groups respectively failed to be retested (singletons). In the hypocalcemia group, 1115/2902 (38.4%) showed corrected serum calcium values of < 2.00 mmol/l), whilst 100/313 subjects (31.9%) of the hypercalcemia group had corrected serum calcium values of > or = 3.00 mmol/l. There were no significant differences between the mean corrected serum calcium between 3 age groups of the test population, namely in childhood ( < or = 65 years).

Matched MeSH terms: Hypercalcemia/epidemiology

Hypercalcaemia in patients with newly diagnosed tuberculosis in Malaysia

Liam CK, Lim KH, Srinivas P, Poi PJ

Int J Tuberc Lung Dis, 1998 Oct;2(10):818-23.

PMID: 9783529

University Hospital, Kuala Lumpur, Malaysia.

Matched MeSH terms: Hypercalcemia/complications; Hypercalcemia/diagnosis; Hypercalcemia/epidemiology*

Hypercalcaemic crisis: immediate parathyroidectomy and intraoperative intravenous calcium infusion improves outcome

Harjit K, Zanariah H, Hisham AN

Asian J Surg, 2007 Jul;30(3):173-7.

PMID: 17638635

The hypercalcaemic crisis of hyperparathyroidism is an endocrine emergency that is invariably fatal if untreated. Despite emergency parathyroidectomies to treat hypercalcaemic crisis, mortality rates remain high. The rapid decline of serum calcium levels after removal of an adenoma and its adverse effect on the heart contributes to the development of postoperative complications and death. The cornerstone of surgical treatment for hypercalcaemic crisis is to begin infusion of high doses of calcium immediately after successful removal of parathyroid adenomas to allow gradual and well-controlled decline of serum calcium to avoid fatal myocardial complications.

Matched MeSH terms: Hypercalcemia/etiology; Hypercalcemia/therapy*

Fulltext Metastatic penile cancer presenting as hypercalcemia and pathological fracture of the humerus: a rare event

Ho CC, Nazri J, Zulkifli MZ, Sritharan S, Hayati AR

Med J Malaysia, 2006 Oct;61(4):503-5.

PMID: 17243535 MyJurnal

Distant haematogenous metastasis in penile cancer is rare. A patient who had total penectomy and bilateral inguinal lymphadenectomy for penile cancer but later presented with hypercalcemia of malignancy and pathological fracture of the humerus is reported.

Matched MeSH terms: Hypercalcemia/diagnosis*; Hypercalcemia/physiopathology

Albumin adjusted calcium: Study in a tertiary care hospital

Mohd Ariffin ZA, Jamaluddin FA

Malays J Pathol, 2020 Dec;42(3):395-400.

PMID: 33361720

INTRODUCTION: One commonly used equation which continues to be widely mentioned in text books and hence familiar to clinical people is total calcium + 0.02 (40 - albumin). This equation was derived using cresophthalein complexone and bromocresol green (BCG) methods for measuring serum total calcium and serum albumin respectively. However this equation maybe invalid when applied to calcium and albumin results generated by alternative assays. Hence we aim to derive an albumin-adjusted calcium equation specific to our laboratory's total calcium and albumin methodologies.

MATERIALS AND METHODS: A total of 3,175 adult University Malaya Medical Centre (UMMC) patients deemed free of any calcium metabolism disorders were selected and divided into two groups for derivation and validation. Simple linear regression associating total calcium and albumin was constructed from the data in the derivation group. The new albumin-adjusted calcium equation was validated in the validation group. Differences in calcium status classification following adjustments based on existing and new albumin-adjusted calcium equation was compared in a 469 hypoalbuminaemic patients.

RESULT: The new albumin adjusted calcium equation was: total calcium + 0.014 x (39-albumin). Of the 469 hypoalbuminemic patients, 78 were classified differently based on new equation. Based on the new equation, 55 normocalcemic patients were classified as hypocalcemic and 22 were classified as normocalcemic instead of hyperclacaemic.

CONCLUSION: Based on the newly derived albuminadjusted calcium equation 17% of patients had different adjusted calcium classifications. This could potentially impact in the management. It is recommended that laboratories derive equations specific to their calcium/albumin methods and analytical platforms.

Matched MeSH terms: Hypercalcemia/blood; Hypercalcemia/diagnosis

Limitations of calculated ionised calcium & adjusted calcium in critically ill patients: Time to consider measured ionised calcium

Zulkufli NS, Jamaluddin FA, Tengku Yazid TN

Malays J Pathol, 2020 Dec;42(3):385-394.

PMID: 33361719

INTRODUCTION: Ionised calcium is a good prognostic and diagnostic tool as opposed to total calcium in critical patients but is not available in most central laboratories and non-intensive care units. To date, four equations to calculate ionised calcium in critical patients have been published.

OBJECTIVES: (1) Evaluate the four published equations' performance in estimating ionised calcium; (2) Determine the accuracy of calculated ionised and adjusted total calcium in classifying patients according to calcium states; and (3) Identify factors associated with hypocalcaemia in the critically ill population.

MATERIALS AND METHODS: This is a cross-sectional study involving 281 critically ill patients aged 18-80 years of both genders in a Malaysian tertiary intensive care unit. Performance of the four equations was analysed using Bland-Altman difference plot and Passing Bablok regression analysis. Crosstabulation was conducted to assess classification accuracy. Mann-Whitney U or Pearson Chi-Square tests were performed to identify variables associated with hypocalcaemia.

RESULTS: Calculated ionised calcium using all four equations significantly overestimated ionised calcium. Calculated ionised and adjusted total calcium had poor accuracies in classifying hypocalcaemic patients. pH was significantly higher in hypocalcaemics.

CONCLUSION: Calculated ionised and adjusted total calcium significantly overestimate ionised calcium in the critically ill. In this specific population, calcium status should only be confirmed with ionised calcium measured by direct ion-selective electrode (ISE).

Matched MeSH terms: Hypercalcemia/blood; Hypercalcemia/diagnosis

Fulltext Hypercalcemia in a patient with tuberculous mediastinal lymphadenopathy

Tan TT, Lee BC, Zainuddin BM, Wong KT, Samad A, Khalid BA

Singapore Med J, 1991 Feb;32(1):87-9.

PMID: 2017716

We describe the case of a 48 year old Indian female with hypercalcemia due to tuberculosis. She presented with symptoms of hypercalcemia and chest radiographs showed bilateral hilar lymphadenopathy with normal lung fields. The diagnosis of tuberculosis was made histologically from biopsy of the enlarged hilar nodes. Her hypercalcemia resolved following one month of anti-tuberculous treatment. The prevalence of hypercalcemia in tuberculosis has been reported to be high in western series. There is, however, a paucity of local data on the subject. The presence of 1-alpha-hydroxylase-like activity in pulmonary alveolar macrophages with resulting increased formation of active vitamin D metabolites is the postulated mechanism of tuberculosis associated hypercalcemia.

Matched MeSH terms: Hypercalcemia/diagnosis; Hypercalcemia/etiology*

Adrenal involvement in histoplasmosis

Wahab NA, Mohd R, Zainudin S, Kamaruddin NA

EXCLI J, 2013;12:1-4.

PMID: 27047312

Histoplasmosis infection is endemic in Asia and disseminated histoplasmosis (DH) is one form of its presentation (Benevides et al., 2007[1]). DH commonly affects both adrenal glands. We describe a case of disseminated histoplasmosis complicated with hypercalcaemia in a 75-year-old immunosuppressed patient who presented with bilateral adrenal masses. The fine needle aspiration cytology of the adrenal mass was positive for Histoplasma capsulatum.

Matched MeSH terms: Hypercalcemia

Denosumab as a long-term palliative therapy in parathyroid carcinoma

Tong CV, Loh LT, Hussein Z

QJM, 2017 01;110(1):55.

PMID: 28011854 DOI: 10.1093/qjmed/hcw207

Matched MeSH terms: Hypercalcemia

Fulltext Calcitriol-mediated Reversible Hypercalcemia in a Patient with Primary Adrenal Lymphoma

Mir SA, Masoodi SR, Wani AI, Ahmad SN, Hameed I

Malays J Med Sci, 2016 Nov;23(6):118-122.

PMID: 28090186 DOI: 10.21315/mjms2016.23.6.13

Primary adrenal lymphomas (PAL) are rare occurrences with only less than 150 cases reported in the literature. Two-thirds of these cases were reported in the last decade due to the advancements in imaging techniques and immunohistochemistry. The non-specific signs and symptoms have resulted in a delayed onset of symptoms and diagnosis of these tumors. Reports of the results of chemotherapy are not gratifying, and most patients die within one year of the diagnosis. We report a 65-year-old male with adrenal non-Hodgkin's lymphoma (NHL), who presented with hypercalcemia and renal failure. We reviewed all adrenal NHL cases presented with hypercalcemia and attempted to comprehend its etiology and overall survival effect.

Matched MeSH terms: Hypercalcemia

Large retrosternal parathyroid carcinoma with primary hyperparathyroidism

Tan GC, Shiran MS, Swaminathan M, Phang KS, Rohaizak M

Asian J Surg, 2007 Oct;30(4):286-9.

PMID: 17962134

Parathyroid carcinoma is an uncommon cause of parathyroid hormone (PTH)-dependent hypercalcaemia, accounting for less than 1% of all cases of hyperparathyroidism. Parathyroid carcinoma is an indolent tumour with rather low malignant potential. Consideration of parathyroid carcinoma in the differential diagnosis of hypercalcaemic disorders is important because the morbidity and mortality are substantial and the best prognosis is associated with early recognition and surgical resection. Clinical indicators favouring parathyroid carcinoma over benign disease include markedly raised serum calcium levels, PTH and alkaline phosphatase. A palpable neck mass with both kidney and skeletal manifestations also give a high index of suspicion of parathyroid carcinoma. Histopathology alone is not sufficient to diagnose parathyroid cancer; it has to be correlated with the clinical findings. The initial and most effective treatment for parathyroid carcinoma is complete resection of the primary lesion, and repeated operations for recurrence are useful. The prognosis of parathyroid carcinomas is quite variable; 5-year survival rates vary from 40% to 86%, while the 10-year survival rate is approximately 49%. We report a case of parathyroid carcinoma occurring in a 55-year-old woman who presented with bone pain and hypercalcaemia.

Matched MeSH terms: Hypercalcemia/etiology

Fulltext Hypercalcaemic crisis as the presenting manifestation of abdominal tuberculosis: a case report

Ramanathan M, Abdullah ADG, Sivadas T

Med J Malaysia, 1998 Dec;53(4):432-4.

PMID: 10971990

This report deals with a young man having prolonged fever presenting with hypercalcaemic crisis. Subsequent investigations confirmed tuberculosis (TB) peritonitis in the absence of pulmonary involvement as the cause of his symptoms. His hypercalcaemia and fever resolved with anti-TB therapy. Abdominal TB needs to be included in the differential diagnosis of otherwise unexplained hypercalcaemia especially in our region where TB is an endemic problem and is treatable.

Matched MeSH terms: Hypercalcemia/microbiology*

Fulltext Primary hyperparathyroidism with carcinoma of the right breast--a case report

Muin IA, Meah FA

Med J Malaysia, 1994 Sep;49(3):301-2.

PMID: 7845286

A patient with carcinoma of the right breast and coincidental primary hyperparathyroidism is presented. The distinction between hypercalcemia of malignant and hyperparathyroid origins is based on biochemical analysis and localisation of parathyroid adenoma on a computer tomogram of the neck.

Matched MeSH terms: Hypercalcemia/etiology*

Fulltext Congenital mastoid cholesteatoma presenting as a mass obstructing external auditory canal

Khairunnisak M, Mohd Khairi MD

Med J Malaysia, 2014 Dec;69(6):277-8.

PMID: 25934960 MyJurnal

We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 - 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck's traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions.

Matched MeSH terms: Hypercalcemia

Fulltext Denosumab as the Treatment of Recalcitrant Tuberculous Pleural Effusion-Associated Hypercalcemia

Abd Jalil AA, Wan Muhamad Hatta SF, Mohamad AF, Abdul Rani MF

Case Rep Med, 2021;2021:5544848.

PMID: 33986809 DOI: 10.1155/2021/5544848

Denosumab is a human monoclonal antibody that binds to RANKL (receptor activator of nuclear factor-kappa B ligand). It has mainly been used in the treatment of osteoporosis for a variety of causes especially in situations refractory to bisphosphonates or when kidney function is impaired. It is also used in cases of malignancy-associated hypercalcemia. There are many causes of hypercalcemia, but only rarely it is associated with granulomatous diseases such as tuberculous pleural effusion. We report a case of hypercalcemia from tuberculous pleural effusion that was initially admitted with left medium abundance pleural effusion and a serum corrected calcium level of 3.48 mmol/L. The calcium level was successfully normalized within 72 hours of subcutaneous denosumab administration after other interventions have failed.

Matched MeSH terms: Hypercalcemia

Fulltext Primary hyperparathyroidism with hungry bone syndrome - A Case Report

Norazmi, K., Khairul, A.J.

International Medical Journal Malaysia, 2007;6(2):1-7.

MyJurnal

Primary hyperparathyroidism with severe bone disease as a result of excessive parathyroid hormone ( PTH ) release and severe hypercalcaemia can lead to 'hungry bone syndrome' (HBS) post operatively. This is due to sudden cessation of PTH and drop in serum calcium. We reported a case a young man with primary hyperparathyriodism due to a single parathyroid adenoma with severe bone disease and post operatively developed hungry bone syndrome.

Matched MeSH terms: Hypercalcemia

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